Lifestyle changes that affect gut bacteria may help to prevent and treat auto-immune diseases such as rheumatoid arthritis and psoriasis. More than 50 million Americans suffer from autoimmune diseases that look just like a person has an infection because laboratory tests show that a person has an over-active immunity that is trying to kill some germ. However, doctors cannot find any germ that could be causing the person's symptoms. For example, auto-immune types of arthritis, such as rheumatoid and reactive arthritis, appear to be caused by an infection, but researchers have been unable to find any specific germ that causes them.

Auto-immune diseases include rheumatoid arthritis and many other types of arthritis; lupus and other total body diseases; inflammatory bowel and other intestinal diseases; Type 1 diabetes; Guillain-Barre, myasthenia gravis and other nerve diseases; psoriasis and other skin diseases, Graves', Hashimoto's and other thyroid diseases; and so forth. The most promising research on auto-immune diseases today shows that the bacteria that inhabit the intestines of people with these diseases are different from those of normal people, and the treatment may be to rid the intestines of the harmful bacteria and replace them with healthful ones (eLife, Nov 5, 2013;2(0)). Further research is needed since we do not yet know how to do this or whether it would be successful.

What are Auto-immune Diseases?
If you go to your doctor with bothersome symptoms in any part of your body, your doctor may order a lot of tests and find out that your immunity is overactive. If he looks for a causative germ and cannot find one, he is likely to say, "You have an auto-immune disease." He is telling you that he doesn't have the foggiest idea why you are sick. Often you will be given a drug that suppresses your immunity and usually you will feel better for some time. However, immune suppressant drugs do not cure auto-immune diseases and the drugs have many side effects, including increasing your risk for serious infections and cancers. Everyone agrees that we need better diagnoses and better treatments.

Recent Breakthroughs
Your intestines are full of more than two hundred different species of beneficial bacteria that serve many useful functions. For example, they ferment undigested carbohydrates so they can be absorbed for energy, and they keep harmful bacteria in check. We know that intestinal bacteria help to control your immunity. Now we are learning that changes in the normal bacteria that live in your intestines may cause autoimmune diseases such as rheumatoid arthritis. When a germ gets into your bloodstream, your immunity makes cells and proteins to try to kill that germ. People who have auto-immune diseases usually have increased circulating auto-antibodies (directed against their own cells) and pro-inflammatory cytokines (that keep their immunities turned on) for many years before they develop overt symptoms of their disease.

The intestines of people with rheumatoid arthritis or psoriatic arthritis contain bacteria called Provotella copri (eLife. Nov 5, 2013;2(0)) and also have reduced levels of the good, healthful intestinal bacteria (Bacteroides, Lachnospiraceae, and Clostridia). However, only the intestines of recent-onset rheumatoid arthritis patients have a single Provotella species. Provotella copri levels are usually normal in treated RA patients. This suggests that the immune suppressive drugs used to treat rheumatoid arthritis somehow suppress the nasty germ associated with early rheumatoid arthritis. Furthermore, P. copri breaks down methotrexate, the most-used drug to treat rheumatoid arthritis. P. Copri also is a major cause of gum and tooth infections that markedly increase a person's chances of suffering an auto-immune disease and even heart attacks. The same intestinal germs that are associated with rheumatoid arthritis are also associated with other types of arthritis, inflammatory bowel disease, allergic brain encephalomyelitis and type-1 diabetes.

Doctors order blood tests for certain antibodies to make a diagnosis of rheumatoid arthritis. These anticitrullinated and anticarbamylated antibodies can be present for years before a person even develops symptoms of rheumatoid arthritis (Ann Rheum Dis, published online July 9, 2015). The authors state that it is likely that these antibodies cause rheumatoid arthritis. Dan R. Littman, from New York University School of Medicine, found that P. copri was more abundant in patients newly diagnosed with rheumatoid arthritis than in healthy individuals or patients with chronic, treated rheumatoid arthritis. The presence of P. copri is also associated with having fewer of the beneficial gut bacteria called Bacteroides.

Lifestyle Changes to Help Treat and Prevent Auto-immune Disease
Unfortunately we have no completely safe and effective drug treatments for auto-immune diseases, but we do know some of the lifestyle factors associated with increased risk for, and worsening of, rheumatoid arthritis. Researchers reviewed the records of 25,455 people and showed that those who smoked, were overweight or had diabetes were at significantly increased risk for developing rheumatoid arthritis (Ann Rheum Dis, Mar 16, 2013). The lifestyle changes recommended for rheumatoid arthritis patients should apply to all auto-immune disease sufferers:

• Exercise. Patients with rheumatoid arthritis do much better when they exercise regularly (Physiol Behav, 2008, published online). They can improve both muscle strength and endurance (Joint Bone Spine, 2008;75(1):11–17). Exercising for as little as 20 minutes a day three times a week reduced fatigue and disability (Fam Community Health, 2006;29(4):320–327). Exercising reduces pain, fatigue, and depression and improves grip strength and walk time (Arthritis Rheum, 2007;57(6):943–952).

Some articles show that vegan diets help to reduce pain and suffering in rheumatoid arthritis, but the data is weak (Scand J Rheumatol, 1986;15:219-223 and J Altern Complement Med, 2002;8(1):71-75). Several articles show that vegan diets improve joint pain and motion in rheumatoid patients (Arthritis and Rheumatism, 1983;26:462-471; Acta Derm Venereol, 1983;63:397-403; Rheumatology (Oxford), 2001;40(10):1175-1179; Scand J Rheumatol, 2001;30(1):1-10). Patients who go on vegan diets usually lose weight which reduces inflammation to help treat rheumatoid arthritis. Vegetables are loaded with antioxidants, which helps reduce inflammation.

Meats appear to worsen rheumatoid arthritis, possibly because they contain large amounts of highly-absorbable iron. Excess iron damages tissues to increase inflammation and worsen arthritis. Dairy products may aggravate rheumatoid arthritis (Scand J Rheumatol, 1979;8:249-255). The data associating milk with worsening of rheumatoid arthritis is very weak but galactose, the sugar in milk, turns on your immunity to cause inflammation. Yogurt and cheeses are low in galactose as they are made by fermenting dairy products which breaks down galactose.

• Weight Reduction. Obese people are at significantly increased risk for developing rheumatoid arthritis (Arthritis Care & Research, January 2013;65(1):71–77). Most people lose a lot of weight when they first develop rheumatoid arthritis. The disease destroys tissues and patients lose muscles, tendons, joints and bone as the disease progresses. However, having excess fat is associated with increased pain, limitation of motion, and reduced quality of life in patients with rheumatoid arthritis (Clin Rheumatol, 2007;26:1831–1835). Fat cells produce cytokines that turn on your immunity to cause inflammation that triggers rheumatoid arthritis.

What Does this Mean If You Have an Auto-immune Disease?
Lifestyle changes will not cure rheumatoid arthritis or any other auto-immune disease, but they can help to reduce the overactive immunity (inflammation) that causes joint destruction and other symptoms. We know that inflammation is promoted by chronic infections, full fat cells, diabetes, high blood sugar, lack of exercise, smoking, alcohol, and everything else that damages your body. You can reduce inflammation by losing excess weight, avoiding smoke and alcohol, treating chronic infections, exercising, and following a healthful diet which includes lots of fruits and vegetables and restricting animal products and sugar-added drinks and foods. We await further research on gut bacteria and auto-immune diseases.Exercise for Better Gut BacteriaGut Bacteria and Weight Loss

About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities.
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